title: Increased-offset reverse shoulder arthroplasty for the treatment of failed post-traumatic humeral head replacement.
abstract: BACKGROUND
  Late complications after humeral head replacement (HHR) for comminuted proximal humeral fractures are common and may necessitate revision surgery. This study evaluated the outcome of revision surgery of failed post-traumatic HHR with a less medialized reverse shoulder prosthesis.
  
  
  METHODS
  Thirty-three patients with failed post-traumatic HHR due to rotator-cuff insufficiency and glenoid erosion, but with sufficient preservation of the glenoid bone stock to permit primary stability of an inverted glenoid implant, underwent revision using the Bayley-Walker reverse shoulder prosthesis (Stanmore Implants, Elstree, UK) and were monitored up for a mean of 31 months. Outcome measures included the Oxford Shoulder Score, subjective shoulder value, pain rating, active range of motion, and shoulder radiographs.
  
  
  RESULTS
  The average postrevision Oxford Shoulder Score and subjective shoulder value improved from 50 ± 6 to 29 ± 11 and from 23 ± 19 to 51 ± 23, respectively (P < .001). Pain level decreased from 6.2 ± 2.1 to 1.4 ± 2.0 (P < .001). Active forward flexion increased from 34° ± 22° to 63° ± 30° and external rotation from 11° ± 14° to 20° ± 16°(P < .01). More patients were able to use their affected arm to reach a functional triangle consisting the mouth, opposite armpit, and ipsilateral buttock after revision (24% vs 73%; P < .001). Seven patients (21%) had postrevision complications. No glenoid loosening or scapular notching occurred.
  
  
  CONCLUSIONS
  Revision of failed post-traumatic HHR with the Bayley-Walker shoulder offers reliable pain relief and improvement in shoulder function with a complication rate similar to other reverse prostheses. Nevertheless, revision shoulder arthroplasty remains challenging with a high rate of complications.
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. Electronic address: ofiruri@gmail.com.
authors.forename: Ofir
authors.initials: O
authors.lastname: Uri
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors.forename: Verona
authors.initials: V
authors.lastname: Beckles
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Higgs
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Falworth
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Middleton
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Lambert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D058430:Humeral Head / Q000000981:diagnostic imaging / Q000293:injuries*; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012399:Rotation; D012784:Shoulder Fractures / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
keywords: Bayley-Walker; Humeral head replacement; arthroplasty failure; glenoid erosion; proximal humerus fracture; revision shoulder arthroplasty; shoulder hemiarthroplasty